Charnley Low Friction Arthroplasty for Osteoarthritis - PowerPoint PPT Presentation

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Charnley Low Friction Arthroplasty for Osteoarthritis
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Charnley Low Friction Arthroplasty for Osteoarthritis

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  1. Charnley Low Friction Arthroplastyfor Osteoarthritis Professor B.M. Wroblewski Mr P. D. Siney Ms P. A. Fleming Mr P. Bobak The John Charnley Research Institute, Wrightington Hospital Research supported by the Peter Kershaw & John CharnleyTrusts in Congenital Dislocation, Subluxation, Dysplasia

  2. "This type of problem is regarded as too extreme for this type of technical procedure, inviting more technical hazards than the degree of disability warrants.” Low Friction Arthroplasty in Congenital Subluxation of the Hip. J. Charnley, J.A. Feagin CORR. No. 91 1973

  3. CDS/OA - % of all LFAs 21263 LFAs

  4. CDS/OA - % of Young Patients 1434 LFAs

  5. CDS/OA - % of LFAs

  6. Underlying Hip Pathology Number % Primary O.A. 298 20.8 CDS/OA 395 27.6 Quadrantic head necrosis 69 4.8 Slipped upper femoral epiphysis 55 3.8 Rheumatoid arthritis 292 20.4 Trauma 85 5.9 Fracture neck of femur 38 2.7

  7. Mean 41 years 4 months Range: 15 - 51 Age at LFA

  8. 300 Patients : 395 LFAs Ratio : 6 Females to 1 Male Number % Male 42 14 Female 258 86 Left 212 54 Right 183 46

  9. Weight Mean 61.5 kgs Range 40 - 98

  10. Bilateral LFAs : 48.1% Patients Hips Bilateral 95 190 Consecutive 22 44 Staged 73 146

  11. Hartofilakidis Classification % A: Dysplastic hip 32.2 B: Low dislocation 56.6 C: High dislocation 11.2

  12. Previous Surgery Number % None 296 75.0 Osteotomy (femoral / pelvic) 59 15.0 Open reduction 17 4.3 Fusion / attempted fusion 10 2.5 Cup arthroplasty 3 0.8 Other (soft tissue procedures) 33 8.6

  13. Cup Used % Offset-bore (38 mm) 10.6 40 mm 47.6 43 mm 41.8

  14. Follow up Mean 16.6 years Range: 1 - 35

  15. Clinical ResultsMerle d’Aubigne and Postel grading

  16. Clinical Results Pain free / Occasional discomfort 89.8 % Normal or near normal function 74.5 % Normal or near normal movement 72.9 %

  17. Complications within one year Number % None 348 88.0 Trochanteric non union 13 3.3 DVT (clinical) 10 2.5 PE (clinical - non fatal) 8 2.0 Dislocation 2 0.5

  18. Complications after one year Number % None 264 66.8 Loose cup 72 18.2 Loose stem 20 5.1 Dislocation 5 1.3 Infection 3 0.8 Fractured stem 3 0.8

  19. Revisions 77 LFAs 19.5%

  20. Indications for Revision } 16.7 Number % Loose cup 59 Cup wear 7 Loose stem 17 4.3 Infection 2 0.5 Exploration 8 2.0

  21. Wear Cup Loosening / Revision

  22. Post-op 13 years

  23. Follow up Number % Lost Patients 26 6.7 LFAs 32 8.8 Died Patients 17 4.4 LFAs 24 6.1 Revised Patients 56 15.0 LFAs 77 19.5 Attending Patients 201 60.2 LFAs 262 66.3 Follow-up 19 years (10-35)

  24. 33 year old MalePre-op

  25. 18 yearsfollow-up

  26. Results of THR for DDH without femoral head autograft Author No Mean FU Revised Loose (years) % % MacKenzie 1996 59 16.0 10 32 Pagnano 1996 145 14.0 19 40 Numair 1997 182 9.9 10 6

  27. Results of THR for DDH withfemoral head autograft Author No Mean FU Revised Loose (years) % % Mulroy 1990 46 11.8 20 26 Spangehl 2001 44 7.5 9 0 Kobayashi 2003 37 19.0 0 0

  28. 45 Charnley LFA's41 patients Women 36 Men 9

  29. Age at LFA Average 46 years 3 months

  30. Preoperative Radiographic Evaluation Hartofilakidis Classification 1988 Dysplasia 1 Low dislocation 29 High dislocation 15

  31. Previous Surgery • Femoral osteotomy 14 • Open reduction 6 • Conservative treatment 6 • Pelvic osteotomies 3 • Soft tissue release 1

  32. Surgical Technique • Trochanteric osteotomy • Identification of the tear-drop • Acetabular preparation

  33. Surgical Technique • Bone graft preparation and fixation

  34. Surgical Technique • Socket fixation

  35. Socket coverage by the bone-graft Average: 26 % Range: 16 - 35 %

  36. Socket used Type Number Offset-bore (38 mm) 9 40 mm 27 43 mm 9

  37. Clinical Results

  38. Bone Graft Union rate 100 %

  39. Bone Graft Resorption No of hips None 18 Mild 24   Moderate 2 Major 1 Time to appearance 3.6 years

  40. Follow-up Average : 17 years 1 month Range: 15 - 21 years

  41. Revised : 3 hips - Aseptic cup loosening 2 - Infection 1 Time to revision 13.1 years

  42. Radiographic Results Socket No of hips Migrated 3 Fully demarcated 4 Hodgkinson et al COOR 1986